All EMS presentations
Mental HealthClinical presentation

Mental health / suicidal ideation

A streamlined, differential-led presentation for rapid clinical review.

Clinical snapshot

Twenty-second review

  • Suicidal thinking and acute psychiatric distress can arise from mood, psychotic, trauma-related, substance-related, or medical illness and require both safety and medical assessment.
  • Current intent, plan, access to means, recent attempt, command hallucinations, severe agitation, or impaired capacity creates immediate safety concern.
  • Keep delirium or intoxication in the differential; overlapping or concurrent illness remains possible.
  • For mental health / suicidal ideation, trends and combinations of findings are more informative than one isolated vital sign.
Differentials

Compare the clinical patterns

The repeated material is grouped inside each possibility. Open only the condition you need.

Serious2 conditions
Imminent self-harmTime-sensitive high-risk possibility

HPI

Clarify primary concern; suicidal thoughts; plan, intent, access to means.

Signs & symptoms

Attempt, concealed ingestion, delirium, psychosis, or severe intoxication.

Focused exam

Observe behaviour, speech, thought process, perception, orientation, attention, and signs of intoxication, injury, or medical illness; Assess risk using direct questions and collateral information.

Brief pathophysiology

Imminent self-harm may cause mental health / suicidal ideation through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.

Temperature (°C)

Screen for medical cause

Fever or hypothermia suggests infection, exposure, or toxicity.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause altered behaviour or weakness.

Heart rate (bpm)

Explain abnormalities

Tachycardia may reflect distress but should not be dismissed.

Blood pressure (mmHg)

Compare with baseline

Hypotension or severe hypertension warrants medical evaluation.

Front-load in the triage report

  • Imminent self-harm: Attempt, concealed ingestion, delirium, psychosis, or severe intoxication.
  • Primary concern.
  • Suicidal thoughts?
Medical causeTime-sensitive high-risk possibility

HPI

Clarify suicidal thoughts; plan, intent, access to means; recent attempt/self-harm.

Signs & symptoms

Attempt, concealed ingestion, delirium, psychosis, or severe intoxication.

Focused exam

Assess risk using direct questions and collateral information; Assess appearance, speech, thought process, perception, orientation, attention, injuries, intoxication, and access to means.

Brief pathophysiology

Medical cause may cause mental health / suicidal ideation through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.

Temperature (°C)

Screen for medical cause

Fever or hypothermia suggests infection, exposure, or toxicity.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause altered behaviour or weakness.

Heart rate (bpm)

Explain abnormalities

Tachycardia may reflect distress but should not be dismissed.

Blood pressure (mmHg)

Compare with baseline

Hypotension or severe hypertension warrants medical evaluation.

Front-load in the triage report

  • Medical cause: Attempt, concealed ingestion, delirium, psychosis, or severe intoxication.
  • Suicidal thoughts?
  • Plan, intent, access to means?
Common2 conditions
DepressiveCommon presentation pattern

HPI

Clarify primary concern; suicidal thoughts; plan, intent, access to means.

Signs & symptoms

Hopelessness, recent loss, escalating thoughts, and reduced supports may dominate.

Focused exam

Observe behaviour, speech, thought process, perception, orientation, attention, and signs of intoxication, injury, or medical illness; Assess risk using direct questions and collateral information.

Brief pathophysiology

Depressive may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.

Temperature (°C)

Screen for medical cause

Fever or hypothermia suggests infection, exposure, or toxicity.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause altered behaviour or weakness.

Heart rate (bpm)

Explain abnormalities

Tachycardia may reflect distress but should not be dismissed.

Blood pressure (mmHg)

Compare with baseline

Hypotension or severe hypertension warrants medical evaluation.

Front-load in the triage report

  • Hopelessness, recent loss, escalating thoughts, and reduced supports may dominate.
  • Primary concern.
  • Suicidal thoughts?
Crisis-related illnessCommon presentation pattern

HPI

Clarify suicidal thoughts; plan, intent, access to means; recent attempt/self-harm.

Signs & symptoms

Hopelessness, recent loss, escalating thoughts, and reduced supports may dominate.

Focused exam

Assess risk using direct questions and collateral information; Assess appearance, speech, thought process, perception, orientation, attention, injuries, intoxication, and access to means.

Brief pathophysiology

Crisis-related illness may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.

Temperature (°C)

Screen for medical cause

Fever or hypothermia suggests infection, exposure, or toxicity.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause altered behaviour or weakness.

Heart rate (bpm)

Explain abnormalities

Tachycardia may reflect distress but should not be dismissed.

Blood pressure (mmHg)

Compare with baseline

Hypotension or severe hypertension warrants medical evaluation.

Front-load in the triage report

  • Hopelessness, recent loss, escalating thoughts, and reduced supports may dominate.
  • Suicidal thoughts?
  • Plan, intent, access to means?
Mimics2 conditions
DeliriumImportant alternative presentation

HPI

Clarify primary concern; suicidal thoughts; plan, intent, access to means.

Signs & symptoms

Fluctuating attention or abnormal physiology suggests a medical contributor.

Focused exam

Observe behaviour, speech, thought process, perception, orientation, attention, and signs of intoxication, injury, or medical illness; Assess risk using direct questions and collateral information.

Brief pathophysiology

Delirium can resemble mental health / suicidal ideation through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.

Temperature (°C)

Screen for medical cause

Fever or hypothermia suggests infection, exposure, or toxicity.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause altered behaviour or weakness.

Heart rate (bpm)

Explain abnormalities

Tachycardia may reflect distress but should not be dismissed.

Blood pressure (mmHg)

Compare with baseline

Hypotension or severe hypertension warrants medical evaluation.

Front-load in the triage report

  • Fluctuating attention or abnormal physiology suggests a medical contributor.
  • Primary concern.
  • Suicidal thoughts?
IntoxicationImportant alternative presentation

HPI

Clarify suicidal thoughts; plan, intent, access to means; recent attempt/self-harm.

Signs & symptoms

Fluctuating attention or abnormal physiology suggests a medical contributor.

Focused exam

Assess risk using direct questions and collateral information; Assess appearance, speech, thought process, perception, orientation, attention, injuries, intoxication, and access to means.

Brief pathophysiology

Intoxication can resemble mental health / suicidal ideation through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.

Temperature (°C)

Screen for medical cause

Fever or hypothermia suggests infection, exposure, or toxicity.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause altered behaviour or weakness.

Heart rate (bpm)

Explain abnormalities

Tachycardia may reflect distress but should not be dismissed.

Blood pressure (mmHg)

Compare with baseline

Hypotension or severe hypertension warrants medical evaluation.

Front-load in the triage report

  • Fluctuating attention or abnormal physiology suggests a medical contributor.
  • Suicidal thoughts?
  • Plan, intent, access to means?
Red flags

Findings that should escalate concern

  • Current intent, plan, access to means, recent attempt, command hallucinations, severe agitation, or impaired capacity creates immediate safety concern.
  • Imminent self-harm or medical cause: Attempt, concealed ingestion, delirium, psychosis, or severe intoxication.
Related EMS presentations

Continue the clinical pathway

ToxicologyOverdose / drug poisoningToxicologyAlcohol intoxicationNeurologicDelirium / acute behavioural changeMental HealthAcute anxiety / panic symptomsMental HealthBehavioural crisis / agitation
References

Clinical and academic sources

Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.

BCEHS Handbook — specific CPGs

  1. G02: Mental Health ConditionsBC Emergency Health Services Handbook

    Official BCEHS clinical practice guidance for mental health conditions.

Supporting clinical and academic evidence

  1. CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians

    Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.

  2. Self-harm: assessment, management and preventing recurrenceNational Institute for Health and Care Excellence

    Evidence-based psychosocial assessment, safety, communication, and risk-management guidance.

  3. Suicide in young people: screening, risk assessment, and interventionBMJ · 2023

    Direct suicide enquiry, risk assessment, safety planning, and trauma-informed communication.